Imaging features of temporomandibular joint synovial chondromatosis with associated osseous degenerative changes

Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is a rare benign disease associated with the formation of multiple cartilaginous nodules in the synovial tissue of the TMJ. This can result in pain, swelling, clicking, limited mouth opening, and osseous degenerative joint changes. A retrospective cross-sectional study was performed to summarize the clinical features, radiographic findings, and surgical and histopathological findings of TMJ SC patients who underwent open surgery over a 24-year period. A radiographic scoring system was used to evaluate osseous changes and correlate condyle and joint fossa degeneration. The study included 38 patients and focused on 38 joints. All 38 of these joints showed degenerative changes in the condyle, while 37 showed osseous degenerative changes in the articular fossa. The degree of condylar degenerative changes was related to the duration of the chief complaints (r = 0.342, P = 0.036) and the histopathological stage of the TMJ SC (r = 0.440, P = 0.006), while the degree of joint fossa degenerative changes was associated with the radiographic extent of the SC (r = 0.504, P = 0.001), type of calcification (r = 0.365, P = 0.024), and the histopathological stage (r = 0.458, P = 0.004).

MicroRNA-206 Contributes to the Progression of Preeclampsia by Suppressing the Viability and Mobility of Trophocytes via the Inhibition of AGTR1

The development of preeclampsia (PE) is associated with the impaired trophoblast motility. MicroRNAs (miRs) contribute to the modulation of trophoblast invasion. In the current study, the role of miR-206/AGTR1 in the TNF-alpha-induced invasion defect of trophoblasts was explored. The levels of miR-206 and ATGR1 in clinical placenta tissues were investigated. Trophoblasts were treated with TNF-alpha, and the levels of miR-206 and ATGR1 were modulated. Changes in cell viability, invasion, and inflammation in trophoblasts were detected. The level of miR-206 was induced, while the level of AGTR1 was suppressed in placenta tissues. In in vitro assays, TNF-alpha suppressed viability, induced inflammatory response, inhibited invasion, upregulated miR-206, and down-regulated AGTR1. The inhibited expression of miR-206 or the overexpression of AGTR1 counteracted the effects of TNF-alpha, indicating the key role of the miR-206/AGTR1 in progression of PE. Collectively, miR-206 suppressed viability, induced inflammatory response, and decreased invasion of trophoblasts by inhibiting AGTR1.

The Efficacy of Silver Sulfadiazine (SSD) Dressing Combined with Recombinant Human Epidermal Growth Factor in the Treatment of Third-Grade Radiation Dermatitis: A Randomized Controlled Study

PURPOSE/OBJECTIVE(S)

Radiation dermatitis is the most common complication of radiation therapy for oncology. Studies have shown that approximately 47% patients develop a second-degree or higher radiation skin reaction after radiotherapy. Although skin products that form a surface barrier such as dressings are standard of care in wound care management, they have been poorly reported in the management of radiation dermatitis. Many systemic and topical treatments have been investigated for the prevention and management of radiation dermatitis, however, how to improve this process is still needed. We hypothesize that silver sulfadiazine (SSD) dressings combined with recombinant human epidermal growth factor (EGF) may accelerate wound healing and reduce painful dressing changes.

MATERIALS/METHODS

Sixty patients who received radiotherapy and developed tertiary radiation dermatitis in our department from January 2019 to December 2022 were selected for the study, and were randomly divided into a control group (n = 30) and an observation group (n = 30) in a 1:1 ratio according to the inclusion criteria, both groups were first aseptically cleared with 0.9% sodium chloride injection and uniformly sprayed with recombinant human epidermal growth factor solution. In the control group, a foam dressing was used, while in the observation group, a silver sulfadiazine dressing was used to cover the wound, and in both groups, a double layer of sterile gauze was fixed on the outer layer. Wound healing time and pain level, and secondary observation endpoints were patient quality of life scores (SF-36, including physical function, psychological function, social function, daily activities, all scored on a percentage scale), patient satisfaction, and skin temperature.

RESULTS

The results of the control group vs. the observation group showed: wound healing time (d) of (12±5.08) vs. (8.57±3.11), p = 0.03; NRS pain score of (2.98±1.65) vs. (2.08±1.66), p = 0.04; quality of life assessment showed: psychological aspects (88.25±8.12) vs. 96.34±6.18), p = 0.0413; physical aspects (85.78±5.71) vs. (94.48±4.09), p = 0.0227; environmental aspects (90.15±3.56) vs. (98.09±1.21), p = 0.0137; satisfaction rate 28 (93.33%) vs. 30 (100.00%) , dissatisfaction rate was 2 (6.67%) vs. 0 (0.00%), p = 0.0086; skin temperature (32.08±0.79) vs. (32.14±0.43), no statistically significant difference p>0.05.

CONCLUSION

This randomized preliminary study showed that silver sulfadiazine dressing combined with recombinant human epidermal growth factor was significantly more effective than foam dressing in the treatment of tertiary radiation dermatitis, accelerating wound healing time, reducing patient painful dressing changes, and improving patient satisfaction.

Investigating Incidence of Nausea and Vomiting in Patients Receiving Concurrent Chemoradiotherapy: A Real-World Cohort Study

PURPOSE/OBJECTIVE(S)

Vomiting and nausea (VN) caused by anticancer agents and/or radiation therapy (RT) can significantly affect a patient's quality of life, leading to poor compliance with further anticancer agents and/or RT. Few studies pay attention to synergistic effect of RT and concurrent highly emetogenic chemotherapy for inducing vomiting and nausea. The aim of this real-world study is to investigate the incidence of VN in patients receiving concurrent chemoradiotherapy (CCRT).

MATERIALS/METHODS

From June 2022 to December 2022, patients receiving concurrent chemoradiotherapy in our center were consecutively enrolled in this study. Patients received moderate and low emetic agents were excluded. The antiemesis regimens were NK1 receptor antagonist plus 5-HT3 antagonist and dexamethasone (NHD) with or without olanzapine, which were recommended by guideline of National Comprehensive Cancer Network. Acute and delayed VN were analyzed in the following stratification factors: tumor site and antiemesis regimen. Acute VN usually occurred after administration of anticancer agents and commonly resolves within the first 24 hours. Delayed VN develops in patients more than 24 hours after anticancer agent administration. The grade of VN was evaluated according to Common Terminology Criteria for Adverse Events Criteria.

RESULTS

A total of 312 patients were enrolled for analysis. During the CCRT period, the incidence rate of acute VN in all patients was 28.2%, the delayed VN occurred in 139 of 312 patients (44.6%). The incidence rate of acute nausea in head and neck, thorax and abdomen were 33.8%, 28.9% and 25.2%, respectively. The incidence rate of acute vomiting in head and neck, thorax and abdomen were 7.0%, 3.9% and 5.2%, respectively. The incidence rate of delayed nausea in head and neck, thorax and abdomen were 51.1%, 35.5% and 45.9%, respectively. The incidence rate of delayed vomiting in head and neck, thorax and abdomen were 14.0%, 5.3% and 9.6%, respectively. There were not significant differences between NHD regimen and NHD plus olanzapine in VN (acute nausea, 25.5% vs. 30.3%, P = 0.356; acute vomiting, 4.4% vs. 6.8%, P = 0.352; delayed nausea, 40.1% vs. 48%, P = 0.166; delayed vomiting, 8.0% vs. 10.8%, P = 0.4). Multivariate logistic regression analysis showed age <50 years (P = 0.030. HR, 95% CI: 1.893, 1.062-3.374) and history of vomiting = 0.017, HR, 95% CI: 2.249, 1.154-4.384) were risk factor for acute nausea; female (P = 0.026, HR, 95% CI: 4.254, 1.192-15.186) and sleeping time <7 hours (p = 0.049, HR, 95% CI: 3.373, 1.003-11.344) were risk factors for acute vomiting; pregnancy (P = 0.011, HR, 95% CI: 2.424, 1.228-4.783) was risk factor for delayed nausea; pregnancy = 0.013, HR, 95% CI: 3.060, 1.269-7.380) and history of vomiting = 0.020, HR, 95% CI: 2.845, 1.182-6.844) were risk factors for delayed vomiting in patients receiving CCRT.

CONCLUSION

CCRT still contributed high incidence of delayed nausea in patients receiving standard antiemesis regimen.

H2H Standardized Nutritional Support Management Mode Improves Nutritional Status of Patients with Head and Neck Cancer Receiving Radiotherapy: A Randomized Controlled Study

PURPOSE/OBJECTIVE(S)

Malnutrition which occurs in 90% patients with head and neck cancer (HNC) receiving concurrent chemoradiotherapy (CCRT). It may lead to inferior efficacy of antitumor treatment, increasing the adverse effects and reducing the quality of life. Several studies reported that hospital to home (H2H) standardized nutritional support management mode improved the nutritional status of patients with HNC during CCRT. However, these published studies were limited by retrospective data and small sample size. This randomized controlled study aimed to explore the improving nutritional status efficacy of H2H whole-course standardized nutritional support management mode in patients with HNC receiving CCRT.

MATERIALS/METHODS

From March 2021 to September 2021, patients with HNC receiving CCRT were randomly assigned into H2H nutrition management group (H2H group) and Routine nutritional management group (RTM group) in a 1:1 ratio. For H2H group, patients not only received individual nutritional management which was formulated by doctors, nutritionists and nutrition nurses from the hospital to the family at least once a week, but also received education of nutrition from network platforms. For RTM group, doctors and nurses made nutrition therapy according to nutritional status of patients. The primary endpoints of this study were nutritional status including weight, BMI, albumin, and hemoglobin. This study has been approved by the Ethics Committee of the First Affiliated Hospital of the Fourth Military Medical University (Ethics Committee Approval Number: KY20222067-F-1).

RESULTS

A total of 60 patients were enrolled in this study. Patient characteristics were well balanced in both arms. Compared with RTM group, patients in H2H group had better nutritional status as below: body weight (62.33±4.37) vs (60.14±4.56) kg, P = 0.037; BMI (21.84±3.01) vs (19.70±2.95) kg/m2, P = 0.033; Alb (39.25±2.17) vs (37.02±2.69) g/L, P = 0.031; Hb (132.7±9.03) vs (125.3±9.28) g/L, P = 0.039. The incidence of grade 3-4 oral mucositis in H2H group was less than RTM group (26% vs. 70%, P = 0.038). The score of quality of life was higher in H2H group compared RTM group (85.60±3.40 vs. 73.48±3.61, P = 0.000). The rate of nursing satisfaction in H2H group was higher than RTM group. Pre- and post-intervention satisfaction was 73.33% and 96.67%, respectively (p = 0.011).

CONCLUSION

H2H standardized nutritional support management model improve nutritional status, quality of life and rate of nursing satisfaction in patients with HNC receiving CCRT.

The Effect of Nursing Intervention Based on HFMEA Model on the Prevention of Radiation Dermatitis: A Randomized Controlled Study

PURPOSE/OBJECTIVE(S)

Radiationdermatitis is one of the most common complications in patients received radiotherapy. Previous studies shown that incidence of radiation induced dermatitis (RD) is 95%. HFMEA (Healthcare Failure Mode and Effect Analysis) is a new model of nursing management. Many studies reported that HFMEA could reduce incidence of complications and adverse events, and significantly improve patient satisfaction.

MATERIALS/METHODS

From March 2023 to October 2022, patients received radiotherapy in our center were recruited in this study. Participants were randomly divided into control group (N = 60) and observation group (N = 60) in a ratio of 1:1. Patients in the control group were given routine skin care, health education before radiotherapy and skin care manual during radiotherapy. Based on the standard care, a HFMEA-based nursing intervention was adopted in the observation group by the following methods: Set up HFMEA care team. HFMEA team is composed of head nurses, wound specialist nurses, psychotherapists, etc. The members of the group searched the literature, case analysis and brainstorming to find out the potential failure reasons in every process of nursing radiotherapy patients in the past. Implementation of targeted measures to improve the corresponding: all patients with radiation dermatitis baseline assessment, focus on high-risk patients to shift, regular guidance medication, responsible nurses check the management of patients' skin every day to strengthen the attention of medical staff and patients' family members to radiation dermatitis. The degree of skin injury, pain and psychological status were compared between the two groups at the end of radiotherapy.

RESULTS

A total of 120 patients were enrolled in this study. Grade 1 RD was the most common in the observation group at the end of radiotherapy, and Grade 2 and 3 skin RD were less in the observation group than in the control group. There was not significant difference in the scores of SAS and SDS between the two groups before and after nursing (P > 0.05). In the observation group, the SAS scores (44.10±11.25 vs. 32.29 ± 7.72, P = 0.016) and SDS scores (40.98 ± 9.12 vs. 30.11 ± 5.23, P = 0.013) were significantly higher than the control group after nursing(P<0.05). The scores of SAS and SDS in the Observation Group were significantly lower than those in the control group. The scores of SAS in the Observation Group VS the control group were 32.29 ± 7.72 VS 39.09 ± 9.37 after nursing, SDS scores of Observation Group VS control group (30.11 ± 5.23 VS 38.76 ± 7.52, P<0.05). The visual analogue scale (Vas) score in the observation group was significantly lower than that in the control group (2.37 ± 0.45 VS 4.02 ± 0.53, P & Lt; 0.001), and the satisfaction degree of patients in the observation group was significantly higher than that in the control group (96.67% VS 80%, p = 0.004).

CONCLUSION

HFMEA model could effectively reduce incidence of RD, eliminate negative emotion, relieve pain and improve nursing satisfaction.

Opioid-free anesthesia with lidocaine for improved postoperative recovery in hysteroscopy: a randomized controlled trial

BACKGROUND

Anesthesia with opioids negatively affects patients' quality of recovery. Opioid-free anesthesia attempts to avoid these effects. This study aimed to evaluate the effect of opioid-free anesthesia on the quality of recovery, using lidocaine on patients undergoing hysteroscopy.

METHODS

A parallel-group, randomized, double-blind, controlled trial was conducted in Yichang Central Peoples' Hospital, Hubei Province, China, from January to April, 2022. We included 90 female patients (age: 18-65 years, American Society of Anesthesiologists Physical Status Class I-II) scheduled for elective hysteroscopy, 45 of whom received lidocaine (Group L), and 45 received sufentanil (Group S). Patients were randomly allocated to receive either lidocaine or sufentanil perioperatively. The primary outcome was the quality of postoperative recovery, which was assessed using the QoR-40 questionnaire (a patient-reported outcome questionnaire measuring the quality of recovery after surgery).

RESULTS

The two groups were similar in age, American Society of Anesthesiology physical status, height, weight, body mass index, and surgical duration. The QoR scores were significantly higher in Group L than Group S. The incidence of postoperative nausea and vomiting, as well as the time to extubation were significantly lower in Group L than Group S.

CONCLUSION

Opioid-free anesthesia with lidocaine achieves a better quality of recovery, faster recovery, and a shorter time to extubation than general anesthesia with sufentanil.

TRIAL REGISTRATION

The trial was registered on January 15, 2022 in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/showprojen.aspx?proj=149386 ), registration number ChiCTR2200055623.(15/01/2022).

[Construction and pathological characterization of 3 animal models of temporomandibular joint degenerative joint disease in mice]

Objective: To explore the pathological characteristics of three mice models of temporomandibular joint degenerative joint disease (TMJDJD), including osteoarthritis and osteoarthrosis, and to provide references for animal experimental study regarding the pathological mechanism of osteoarthritis and osteoarthrosis. Methods: A total of 54 8-week-old male C57BL/6 mice were selected to construct three TMJDJD animal models, including bilateral temporomandibular joint (TMJ) Freund's complete adjuvant (FCA) injection model, bilateral TMJ monosodium iodoacetate (MIA) injection model, and right TMJ discectomy model. FCA injection model (15 mice) was divided into saline injection group, FCA injection group-1 week, FCA injection group-2 week, FCA injection group-4 week and FCA injection group-6 week, 3 mice were used at each time point, with a total of 6 TMJs on both sides. MIA injection model (15 mice) was separated into saline injection group, MIA injection group-1 week, MIA injection group-2 week, MIA injection group-4 week and MIA injection group-6 week, 3 mice were used at each time point, with a total of 6 TMJs on both sides. TMJ discectomy model (24 mice) was split into control group, discectomy group-2 week group, discectomy group-4 week and discectomy group-6 week, six mice were used at each time point, with a total of six right TMJs. General pictures of the bilateral joints area of mice were collected 1 day after drug injection, and stereoscopic images of condylar tissues were collected 4 weeks after microsurgery for discectomy. Mouse TMJ tissue sections from each time point were stained with HE and toluidine blue, respectively, synovial tissues were scored for synovial inflammation, and the percentage of proteoglycan in condylar cartilage was quantitatively analyzed. Results: One day after intra-articular FCA or MIA injection, the width of bilateral TMJ were significantly increased in FCA injection groups [(24.60±0.46) mm] compared with the saline injection group [(21.63±0.52) mm] (t=4.25, P<0.013), the width of bilateral TMJ in MIA injection groups [(24.50±0.62) mm] were also significantly higher than that in saline injection group [(21.40±0.52) mm] (t=3.82, P=0.019). The synovitis scores in FCA injection groups 1, 2, 4, 6 weeks after FCA injection were significantly higher than that of the saline injection group (F=18.09, P<0.001), with the proteoglycan of condylar cartilage increased firstly and then decreased compared with the saline injection group (F=21.59, P<0.001). Condylar cartilage proteoglycan loss in different degrees were observed 1, 2, 4 and 6 weeks after MIA injection (F=13.59, P<0.001), and synovitis scores were increased at different degrees compared with saline injection group (F=14.79, P<0.001). The morphology of condylar cartilage in discectomy groups mice were severely damaged, synovial tissues showed dense connective tissue lesions at 2, 4 and 6 weeks postoperatively, condylar cartilage tissues showed a time-dependent loss of proteoglycan compared with the control group (F=40.62, P<0.001). Conclusions: Intra-articular FCA injection establishes a mouse model of TMJ osteoarthritis with severe synovial inflammation. Intra-articular MIA injection constructs a mouse model of typical TMJ osteoarthritis. Discectomy establishes a mouse TMJ osteoarthrosis model with severe condylar cartilage destruction.

[Correctly distinguish osteoarthrosis and osteoarthritis in temporomandibular joint degenerative disease]

Temporomandibular joint degenerative disease is a common disease in the temporomandibular joint disorders, including osteoarthrosis and osteoarthritis. There were often confused in clinical diagnosis, treatment and basic research both of osteoarthrosis and osteoarthritis. That will affect the choice of clinicians and scientists to the treatment of disease, the judgment of prognosis, and the experimental results. The key to distinguishing the clinical significance of osteoarthrosis and osteoarthritis in temporomandibular degenerative disease lies in how to correctly recognize the main differences between the two, that is, whether there is pain in the temporomandibular joint and the masticatory muscle area. At the same time, it is necessary to judge the course of the disease, whether the two are transforming each other and the clinical significance of other dentistry.

[Impact of Streptococcus pneumoniae colonization in upper airway on the clinical manifestations of children with respiratory syncytial virus infection]

Objective: To investigate the effects of Streptococcus pneumoniae (Spn) colonization and the change of upper airway microbiome on the clinical manifestations in children with respiratory syncytial virus (RSV) infection. Methods: A retrospective cohort included 508 RSV-infected children with pneumonia and hospitalized in Respiratory Department of Children's Hospital of Chongqing Medical University from July 2009 to July 2018. A total of 508 cases of RSV-infected children (RSV non-sequencing group) were divided into 2 groups: children with Spn airway colonization (RSV+Spn group) and children without with Spn airway colonization (RSV group) according to the detection for virus and bacteria in nasopharyngeal aspirate, and these 2 groups were compared in terms of clinical manifestations by chi-square test in different age groups. In addition, in RSV pandemic season from November 2018 to February 2020, nasopharyngeal aspirates were collected from 20 children hospitalized in Respiratory Department of Children's Hospital of Chongqing Medical University and infected with RSV but without any positive detection of bacteria (RSV 16 S-sequencing group) and from children undergoing surgery without any sign of respiratory infection (control group). The difference of microbiome detected by 16 S RNA sequencing was compared using rank sum test between RSV 16 S-sequencing group and control group, and also between children with severe and mild pneumonia in RSV 16 S-sequencing group. Results: A total of 508 RSV non-sequencing group included 346 males and 162 females, and the visiting age was 6 (2, 12)  months. RSV group included 443 cases and RSV+Spn group included 65 cases. In the study 244 cases were aged <6 months and 264 cases were aged ≥6 months. In children aged ≥6 months of RSV non-sequencing group, the proportion of cases presenting fever over 38 ℃ and cases with severe pneumonia in RSV+Spn group were higher than those in RSV group (53.2% (25/47) vs. 34.6% (72/217), 38.3% (18/47) vs. 21.2% (46/217), χ²=5.70,6.15, both P<0.05). RSV 16 S-sequencing group included 16 males and 4 females and the visiting age was 3.0 (1.9, 8.0) months. Airway microbiome diversity in RSV 16 S-sequencing group was lower than that in control group (alpha index: 0.93 (0.42, 2.51) vs. 3.05 (2.88, 3.61), U=60.00, P=0.001). Conclusions: RSV infection is associated with the changes of the upper airway microbiome. When the balance of airway microbiome is broken and the presence of the dominant colonization of Spn follows, it may aggravate the severity of RSV infection in children aged ≥6 months.

ALPK1 Aggravates TMJOA Cartilage Degradation via NF-κB and ERK1/2 Signaling

Temporomandibular joint osteoarthritis (TMJOA) is a common degenerative joint disease without effective intervention strategies. Previous research implied that alpha-kinase 1 (ALPK1) is involved in the inflammatory responses of gout, a chronic arthritis. Herein, we found the main distribution of ALPK1 in a proliferative layer of condylar cartilage and marrow cavity of subchondral bone, as well as a lining layer of synovial tissues in human temporomandibular joint. Moreover, the expression of ALPK1 was augmented in degraded condylar cartilage of monosodium iodoacetate (MIA)-induced TMJOA mice. After MIA induction, ALPK1 knockout mice exhibited attenuated damage of cartilage and subchondral bone, as well as synovitis, as compared with wide type mice. In contrast, intra-articular administration of recombinant human ALPK1 aggravated the pathology of MIA-induced TMJOA. Furthermore, ex vivo study demonstrated that ALPK1 exacerbated chondrocyte catabolism by upregulating matrix metalloproteinase 13 and cyclooxygenase 2 by activating NF-κB (nuclear factor-kappaB) signaling and suppressed anabolism by downregulating aggrecan by inhibiting ERK1/2 (extracellular signal-regulated kinase 1/2) in articular chondrocytes. Taken together, ALPK1 exacerbates the degradation of condylar cartilage during TMJOA through the NF-κB and ERK1/2 signaling pathway. This study provides a new insight regarding the role of ALPK1 during TMJOA pathology.

[Clinical investigation and research on Axis Ⅱ evaluation of patients with temporomandibular disorders]

Objective: To screen the physical, psychological and behavioral factors related to patients with temporomandibular disorders (TMD) by using Axis Ⅱ assessment instruments of diagnostic criteria for TMD(DC/TMD). And to provide a reference to establish personalized diagnosis and treatment plans for TMD patients so as to prevent TMD and reduce predisposing factors. Methods: A total of 141 TMD patients, who were admitted in the Department of Oral and Maxillofacial Surgery in School and Hospital of Stomatology, Wuhan University from October 2018 to February 2021 were selected. There were 121 females and 20 males, with an average age of 30 years. A total of 90 healthy people were included as controls. A full-time psychologist conducted relevant questionnaire surveys. The questionnaires include general clinical survey forms and TMD symptom questionnaire. In addition, Axis Ⅱ assessment instruments include graded chronic pain scale, jaw functional limitation scale, oral behaviors checklist, patient health questionnaire-9 (depression), generalized anxiety disorder scale, patient health questionnaire-15 (physical symptoms), etc. The main observational indicators include: pain level, pain impact rates, overall classification of chronic pain, limited chewing function score, limited motor function score, limited communication function score, total jaw function restricted score, depression score, anxiety score, somatic symptom score and oral behavior score.The survey data were imported into SPSS 22.0 software for statistical analysis. Results: In the TMD group 60.3% (85/141) patients had various degrees of pain, 24.1% (34/141) of those with pain effect grades from 1 to 3 and 61.0% (86/141) showed chronic pain overall grades from Ⅰ to Ⅳ. The chewing function restricted score was 2.67(1.17, 4.25), motor function restricted score was 4.25(1.75, 6.12), communication function restricted score was 1.13(1.00, 2.25) and total jaw function restricted score was 2.56(1.47, 4.15) respectively. Patients with mild depression or above accounted for 59.6%(84/141), patients with mild anxiety or above accounted for 56.7%(80/141), 46.1%(65/141) patients had somatization symptoms. Statistical differences (P<0.05) were determined between TMD group and control group in various scores of jaw function, oral behavior grading, depression, anxiety, and physical symptoms. Physical symptoms had significantly statistical difference between different diagnostic classification(P<0.05). Meanwhile, among the different chronic pain levels in the TMD group, there were statistical differences in the various scales of mandibular dysfunction, depression, anxiety, and somatization. In the TMD group, other significant differences were noticed between males and females in terms of the average score of mouth opening, verbal and facial communication, the total score of mandibular dysfunction as well as physical symptoms (P<0.05). Conclusions: Compared with the healthy people, patients with TMD had more abnormal oral behaviors, different restriction of the mandibular functional activities. At the same time, depression, anxiety, and somatization were more serious. Patients with osteoarthritis and subluxation of temporomandibular joint were more likely to suffer physical symptoms. TMD patients suffering from pain had more severe mandibular dysfunction and symptoms of depression, anxiety, and somatization.

Melatonin Abates TMJOA Chronic Pain by MT2R in Trigeminal Ganglion Neurons

Temporomandibular joint osteoarthritis (TMJOA) is one of the most common diseases causing chronic pain in the oral and maxillofacial region. So far, there are few ways to relieve the pain of TMJOA. Melatonin (MT) has a good analgesic effect in many diseases, including fibromyalgia, neuropathic pain, chronic headache, and burn pain, with very low acute toxicity and side effects. This study was to investigate the role and mechanism of MT in TMJOA chronic pain. In rats TMJOA chronic pain occurred at day 14 after an intra-temporomandibular joint injection of monosodium iodoacetate, which we previously reported. The enzyme-linked immunosorbent assay results showed that MT levels were higher in the synovial fluid from patients and rats with TMJOA as compared with those from control. Fluorescent retrograde tracing (Dil) identified that upregulation of MT type 2 receptor (MT₂R) in trigeminal ganglion (TG) neurons innervating rat temporomandibular joints was accompanied by TMJOA chronic pain. Nociceptive behavior as assessed by von Frey and the Rat Grimace Scale demonstrated that exogenous administration of MT relieved chronic pain in TMJOA rats, whereas blocking MT₂R with 4P-PDOT reversed the analgesic effect of MT. Immunofluorescence analysis also confirmed that MT inhibited CGRP and IB4 expression of TG neurons, and this inhibition was reversed by administering the MT₂R antagonist in TMJOA rats. By using Fluo-3 AM-based calcium imaging in vitro, MT elicited calcium transients in Dil⁺ TG neurons, which were significantly abolished by 4P-PDOT. Collectively, this study suggested that MT relieves the TMJOA chronic pain of rats through downregulation of sensitized CGRP⁺ and IB4⁺ neurons in TG via MT₂R. This will be helpful for health care professionals utilizing MT as an option against TMJOA chronic pain.

Aberrantly low STAT3 and STAT5 responses are associated with poor outcome and an inflammatory gene expression signature in pediatric acute myeloid leukemia

The relapse rate for children with acute myeloid leukemia is nearly 40% despite aggressive chemotherapy and often stem cell transplant. We sought to understand how environment-induced signaling responses are associated with clinical response to treatment. We previously reported that patients whose AML cells showed low G-CSF-induced STAT3 activation had inferior event-free survival compared to patients with stronger STAT3 responses. Here, we expanded the paradigm to evaluate multiple signaling parameters induced by a more physiological stimulus. We measured STAT3, STAT5 and ERK1/2 responses to G-CSF and to stromal cell-conditioned medium for 113 patients enrolled on COG trials AAML03P1 and AAML0531. Low inducible STAT3 activity was independently associated with inferior event-free survival in multivariate analyses. For inducible STAT5 activity, those with the lowest and highest responses had inferior event-free survival, compared to patients with intermediate STAT5 responses. Using existing RNA-sequencing data, we compared gene expression profiles for patients with low inducible STAT3/5 activation with those for patients with higher inducible STAT3/5 signaling. Genes encoding hematopoietic factors and mitochondrial respiratory chain subunits were overexpressed in the low STAT3/5 response groups, implicating inflammatory and metabolic pathways as potential mechanisms of chemotherapy resistance. We validated the prognostic relevance of individual genes from the low STAT3/5 response signature in a large independent cohort of pediatric AML patients. These findings provide novel insights into interactions between AML cells and the microenvironment that are associated with treatment failure and could be targeted for therapeutic interventions.

Tobacco smoking confers risk for severe COVID-19 unexplainable by pulmonary imaging

BACKGROUND

COVID-19 is a new pneumonia. It has been hypothesized that tobacco smoking history may increase severity of this disease in the patients once infected by the underlying coronavirus SARS-CoV-2 because smoking and COVID-19 both cause lung damage. However, this hypothesis has not been tested.

OBJECTIVE

Current study was designed to focus on smoking history in patients with COVID-19 and test this hypothesis that tobacco smoking history increases risk for severe COVID-19 by damaging the lungs.

METHODS AND RESULTS

This was a single-site, retrospective case series study of clinical associations, between epidemiological findings and clinical manifestations, radiographical or laboratory results. In our well-characterized cohort of 954 patients including 56 with tobacco smoking history, smoking history increased the risk for severe COVID-19 with an odds ratio (OR) of 5.5 (95% CI: 3.1-9.9; P = 7.3 × 10^-8 ). Meta-analysis of ten cohorts for 2891 patients together obtained an OR of 2.5 (95% CI: 1.9-3.3; P < 0.00001). Semi-quantitative analysis of lung images for each of five lobes revealed a significant difference in neither lung damage at first examination nor dynamics of the lung damage at different time-points of examinations between the smoking and nonsmoking groups. No significant differences were found either in laboratory results including D-dimer and C-reactive protein levels except different covariances for density of the immune cells lymphocyte (P = 3.8 × 10^-64 ) and neutrophil (P = 3.9 × 10^-46 ).

CONCLUSION

Tobacco smoking history increases the risk for great severity of COVID-19 but this risk is achieved unlikely by affecting the lungs.

Radar-based sleep stage classification in children undergoing polysomnography: a pilot-study

STUDY OBJECTIVES

Unobtrusive monitoring of sleep and sleep disorders in children presents challenges. We investigated the possibility of using Ultra-Wide band (UWB) radar to measure sleep in children.

METHODS

Thirty-two children scheduled to undergo a clinical polysomnography participated; their ages ranged from 2 months to 14 years. During the polysomnography, the children's body movements and breathing rate were measured by an UWB-radar. A total of 38 features were calculated from the motion signals and breathing rate obtained from the raw radar signals. Adaptive boosting was used as machine learning classifier to estimate sleep stages, with polysomnography as gold standard method for comparison.

RESULTS

Data of all participants combined, this study achieved a Cohen's Kappa coefficient of 0.67 and an overall accuracy of 89.8% for wake and sleep classification, a Kappa of 0.47 and an accuracy of 72.9% for wake, rapid-eye-movement (REM) sleep, and non-REM sleep classification, and a Kappa of 0.43 and an accuracy of 58.0% for wake, REM sleep, light sleep and deep sleep classification.

CONCLUSION

Although the current performance is not sufficient for clinical use yet, UWB radar is a promising method for non-contact sleep analysis in children.

Direct application of an ECG-based sleep staging algorithm on reflective photoplethysmography data decreases performance

OBJECTIVE

The maturation of neural network-based techniques in combination with the availability of large sleep datasets has increased the interest in alternative methods of sleep monitoring. For unobtrusive sleep staging, the most promising algorithms are based on heart rate variability computed from inter-beat intervals (IBIs) derived from ECG-data. The practical application of these algorithms is even more promising when alternative ways of obtaining IBIs, such as wrist-worn photoplethysmography (PPG) can be used. However, studies validating sleep staging algorithms directly on PPG-based data are limited.

RESULTS

We applied an automatic sleep staging algorithm trained and validated on ECG-data directly on inter-beat intervals derived from a wrist-worn PPG sensor, in 389 polysomnographic recordings of patients with a variety of sleep disorders. While the algorithm reached moderate agreement with gold standard polysomnography, the performance was significantly lower when applied on PPG- versus ECG-derived heart rate variability data (kappa 0.56 versus 0.60, p < 0.001; accuracy 73.0% versus 75.9% p < 0.001). These results show that direct application of an algorithm on a different source of data may negatively affect performance. Algorithms need to be validated using each data source and re-training should be considered whenever possible.

[A preliminary study on the registration of MRI and cone beam CT images of temporomandibular joint disc]

Objective: To evaluate the MRI and cone beam CT (CBCT) image registration methods of the temporomandibular joint (TMJ), and to explore the clinical application of the registered images and clinical diagnostic data for examining the relationship between the articular disc and condyle. Methods: Three patients with TMJ disc disposition were recruited at the Department of Oral and Maxillofacial Surgery, School of Stomatology, Wuhan University from January to March 2018. One patient was male, aged 30, and the others were females, aged 21 and 26 respectively. Three-dimensional (3D) images of CBCT and MRI of the TMJ were reconstructed and registered by using Mimics software. The images were then evaluated after the registration. The evaluation indicators selected were the area and volume of the articular disc, the position of the articular disc or the distance between the highest point of the condyle (point C) to the center point of the articular disc (point D), the distance between the last point of the joint disc (point P) to point C, as well as the angle between line CD and FH plane (∠DCF) at either opened- or closed-mouth condition. Results: The registration images of TMJ, at the closed- and opened-mouth positions of the 3 patients, showed the anatomical structures and interrelationships of the articular disc, articular nodules, joint fossa and condyle. Combined with clinical diagnosis, the difference of CD distances at the normal articular disc position was the minimum (1.94 mm), the difference of CD distances was small at the anterior disc displacement with non-reduction and larger with reduction. When the joint disc was in the opened-mouth position, ∠DCF angle was minimal (3.81°). The patients with anterior disc displacement with non-reduction showed the largest ∠DCF angle (48.03°). Conclusions: The position of the articular disc relative to the condyle and articular nodules, either at closed- or opened-mouth conditionds, could be accurately displayed after the image registration and fusion. The registration image not only could fully show the shape and position of the articular disc in different status from a 3D perspective, but also might provide basis for clinical study of TMJ disc displacement.

[Experts consensus on MRI examination specification and diagnostic criteria of temporomandibular joint disc displacement]

The document represented the consensus amongst the professionals from the Society of TMD & Occlusion, Chinese Stomatological Association and provided guidelines with the MRI examination specification and diagnostic criteria of temporomandibular joint disc displacement.

Synovial fluid levels of VEGF and FGF-2 before and after intra-articular injection of hyaluronic acid in patients with temporomandibular disorders: a short-term study

Our purpose was to measure the temporomandibular joint (TMJ) synovial fluid (SF) levels of vascular endothelial growth factor (VEGF) and fibroblast growth factor-2 (FGF-2) before and after intra-articular injection of hyaluronic acid (HA) and to investigate the possible mechanism involved in the therapeutic value of HA. We analysed the synovial fluid of 30 patients with unilateral internal derangement (ID) or osteoarthritis (OA) of the TMJ (confirmed by magnetic resonance imaging and cone-beam computed tomography) and recorded clinical signs and symptoms including maximal mouth opening, subjective joint pain, and joint noise at the patient's each visit. All clinical signs significantly improved after injection of HA, and there was no significant difference between ID and OA groups. In synovial fluid parameters, the concentration of VEGF was significantly higher before treatment with HA than after treatment, but there was no significant difference in the concentration of FGF-2 between before and after treatment. The study findings suggest intra-articular injection of HA may reduce the synovitis and improve the internal state of the TMJ in a short period.

Relevance of spectral peaks in electromyographic recordings during force-modulated vibration exercise

Vibration exercise (VE) has been suggested for effective muscle training and conditioning. Surface electromyogram (EMG) is employed as a powerful tool for the analysis of VE. However, sharp peaks are observed in the EMG spectrum. The interpretation of these peaks is controversial, complicating the extraction of EMG parameters for VE analysis. The present study is therefore aiming at quantifying the relevance of these spectral peaks in EMG recording during VE. To this end, surface EMG was recorded on the biceps brachii during VE at different amplitudes and frequencies. The power percentage contained in the two narrow bands (±0.5 Hz) around the vibration frequency and its first harmonic (PPv) was calculated. The root mean square (RMS) value of the EMG was calculated with and without including the spectral peaks and then compared. The results show an average PPv value of 20.7 ± 7.9 % and a relative RMS difference (∆RMS) of 12.2 ± 3.8 %. In PPv and addition, RMS∆ seem to be influenced by vibration amplitude and frequency. Our results provide useful information for the analysis of VE and contribute to better understanding of the EMG spectral peaks.

Ultrastructure of intestinal mucosa in diarrhea-predominant irritable bowel syndrome

OBJECTIVES

Impaired intestinal barrier function has been demonstrated in the pathophysiology of diarrhea-predominant irritable bowel syndrome (IBS-D). This study aimed to describe the intestinal ultrastructural findings in the intestinal mucosal layer of IBS-D patients.

METHODS

In total, 10 healthy controls and 10 IBS-D patients were analyzed in this study. The mucosa of each patient's rectosigmoid colon was first assessed by confocal laser endomicroscopy (CLE); next, biopsied specimens of these sites were obtained. Intestinal tissues of IBS-D patients and healthy volunteers were examined to observe cellular changes by transmission electron microscopy (TEM).

RESULTS

CLE showed no visible epithelial damage or inflammatory changes in the colonic mucosa of IBS-D compared with healthy volunteers. On transmission electron microscopic examination, patients with IBS-D displayed a larger apical intercellular distance with a higher proportion of dilated (>20 nm) intercellular junctional complexes, which was indicative of impaired mucosal integrity. In addition, microvillus exfoliation, extracellular vesicle as well as increased presence of multivesicular bodies were visible in IBS-D patients. Single epithelial cells appeared necrotic, as characterized by cytoplasmic vacuolization, cytoplasmic swelling, and presence of autolysosome. A significant association between bowel habit, frequency of abdominal pain, and enlarged intercellular distance was found.

CONCLUSION

This study showed ultrastructural alterations in the architecture of intestinal epithelial cells and intercellular junctional complexes in IBS-D patients, potentially representing a pathophysiological mechanism in IBS-D.

Alterations in Brain Metabolites in Patients with Epilepsy with Impaired Consciousness: A Case-Control Study of Interictal Multivoxel 1H-MRS Findings

BACKGROUND AND PURPOSE

Previous studies have shown perfusion abnormalities in the thalamus and upper brain stem in patients with epilepsy with impaired consciousness. We hypothesized that these areas associated with consciousness will also show metabolic abnormalities. However, metabolic abnormalities in those areas correlated with consciousness has not been characterized with multiple-voxel ¹H-MRS. In this study, we investigated the metabolic alterations in these brain regions and assessed the correlation between seizure features and metabolic alterations.

MATERIALS AND METHODS

Fifty-seven patients with epilepsy and 24 control subjects underwent routine MR imaging and 3D multiple-voxel ¹H-MRS. Patients were divided into 3 subgroups: focal impaired awareness seizures (n = 18), primary generalized tonic-clonic seizures (n = 19), and secondary generalized tonic-clonic seizures (n = 20). The measured metabolite alterations in NAA/Cr, NAA/(Cr + Cho), and Cho/Cr ratios in brain regions associated with the consciousness network were compared between the patient and control groups. ROIs were placed in the bilateral inferior frontal gyrus, supramarginal gyrus, cingulate gyrus, precuneus, thalamus, and upper brain stem. Correlations between clinical parameters (epilepsy duration and seizure frequency) and metabolite alterations were analyzed.

RESULTS

Significantly lower NAA/Cr and NAA/(Cho + Cr) ratios (P < .05 and < .01, respectively) were observed in the bilateral thalamus and upper brain stem in all experimental groups, and significantly high Cho/Cr ratios (P < .05) were observed in the right thalamus in the focal impaired awareness seizures group. There were no significant differences in metabolite ratios among the 3 patient groups (P > .05). The secondary generalized tonic-clonic seizures group showed a negative correlation between the duration of epilepsy and the NAA/(Cr + Cho) ratio in the bilateral thalamus (P < .05).

CONCLUSIONS

Metabolic alterations were observed in the brain stem and thalamus in patients with epilepsy with impaired consciousness.

High altitude species, high profits: Can the trade in wild harvested Fritillaria cirrhosa (Liliaceae) be sustained?

ETHNOPHARMACOLOGICAL RELEVANCE

Fritillaria cirrhosa D. Don bulbs contain alkaloids and are one of the most intensively exploited alpine Himalayan medicinal species. In terms of proprietary medicines, our study shows that 210 F. cirrhosa products are offered by 46 suppliers, most of which (44) are situated in China and two in Nepal. A widespread commercial use is as one of the main ingredients in cough syrups. A well known example is "Nin Jiom Pei Pa Koa Herbal Cough & Throat Syrup", which typically contains more F. cirrhosa than any other herbal ingredient in the formulation. The biggest market for F. cirrhosa bulbs is China, where demand exceeds supply of this wild harvested species for use in traditional Chinese medicine (TCM). Cross-border trade from Nepal to China occurs in significant quantities. Bhutan also imports F. cirrhosa bulbs from Nepal. In addition, F. cirrhosa is registered as an active ingredient in traditional herbal medicinal preparations in Australia, Canada, Hong Kong SAR, Malaysia, Republic of Korea, Singapore and Taiwan. There is also an export trade in F. cirrhosa to Europe. Assessing how much F. cirrhosa is traded is complex, however, due to a "look-alike" challenge, as nine Chinese Fritillaria species are traded in Europe (Fritillaria cirrhosa, F. delavayi, F. hupehensis, F. pallidiflora, F. przewalskii, F. thunbergii, F. unibracteata, F. ussuriensis and F. walujewii).

AIMS OF THE STUDY

The aims of this review were to assess the scale of the global trade in F. cirrhosa, and to synthesise studies of the impacts of wild harvest on F. cirrhosa populations and on the extent of emerging cultivation initiatives as an alternative to wild harvest.

METHODS

Firstly, we reviewed published information on studies on impacts of wild F. cirrhosa harvest from across the geographic range of this species. Secondly, global trade data for F. cirrhosa were analysed.

RESULTS

The principal demand for F. cirrhosa bulbs is in China, where hundreds of different companies produce Fritillaria preparations. Trade data also show that in 2013, China exported over 44 tonnes of F. cirrhosa bulbs to Taiwan and 26.7 tonnes to the Republic of Korea. Extensive commercial use and limited wild stocks result in a high price (2000 - 3800 CNY per kg (around US$ 303 -560 per kg in 2017)) for F. cirrhosa bulbs. Prices of cultivated Fritillaria bulbs are much lower (600-680 CNY per kg in 2017) than wild harvested bulbs. But due to very specific growth requirements of F. cirrhosa, cultivation is not yet able to meet total demand. The consequence is continued exploitation of wild stocks. At the same time, however, an increasing proportion of the demand is met by cultivation of alternative Fritillaria species that are easier to grow than F. cirrhosa. The air-dry mass of F. cirrhosa bulbs varies between 0.0917 and 0.1116 g per bulb. This represents 8960 - 10,900 bulbs/kg or 8.9 - 10.9 million bulbs per tonne. Current demand therefore represents billions of bulbs per year.

CONCLUSIONS

Demand for F. cirrhosa bulbs, particularly from China, makes this species one of the most intensively harvested alpine Himalayan medicinal bulbs. Although F. cirrhosa is listed as a Class III protected species in China, billions of these tiny, wild harvested bulbs are sold per year. Due to demand exceeding supply, the price of F. cirrhosa bulbs has increased dramatically. Between 2002 and 2017, for example, the price of wild harvested F. cirrhosa bulbs increased over nine-fold, from the equivalent of US$60 in 2002 to US$560 per kg in 2017. To date, cultivation has been unable to meet the entire market demand for F. cirrhosa bulbs, although other Fritillaria species are successfully cultivated on a larger scale.

Reconstruction of the oral commissure in patients with unilateral transverse facial cleft

The normal commissure is not a simple joint of the upper and lower lip, but a triangular mucosal area. To reconstruct a symmetrical oral commissure in patients with a unilateral transverse facial cleft, we designed composite vermilion flaps, including triangular flaps. We retrospectively studied 17 patients with unilateral transverse facial clefts from 2013-2016. Three-dimensional images were obtained with a 3-dimensional photogrammetry system at the 1-year follow-up, and we used an anthropometric method to evaluate the postoperative symmetry of the commissure. No obvious deformity was found during the follow-up examination, and comparison of the cleft and non-cleft sides by the paired samples t test showed that in all cases both horizontally and vertically symmetrical commissures had been achieved.

Butyrate promotes visceral hypersensitivity in an IBS-like model via enteric glial cell-derived nerve growth factor

BACKGROUND

Altered visceral sensation is common in irritable bowel syndrome (IBS) and nerve growth factor (NGF) participates in visceral pain development. Sodium butyrate (NaB) could induce colonic hypersensitivity via peripheral up-regulation of NGF in animals. Enteric glial cells (EGCs) appear to be an important source of NGF. Whether butyrate could induce visceral hypersensitivity via increased EGC-derived NGF is still unknown.

METHODS

CRL-2690 cells were used for transcriptome analyses after butyrate treatment. Rats received butyrate enemas to induce colonic hypersensitivity. Colorectal distention test was performed to assess visceral sensitivity. Immunofluorescence studies were used to evaluate the co-expression of glial fibrillary acidic protein (GFAP) and NGF or growth associated protein 43 in animal model. NGF expression in rat colon was also investigated. In vitro, CRL-2690 cells were stimulated with NaB or trichostatin A (TSA). NGF or GFAP expression was also examined.

KEY RESULTS

Transcriptome analyses showed that butyrate induced marked changes of genes expression related to neurotrophic signaling pathways. NaB-treated rats showed increased visceral sensitivity. An improved NGF expression level was observed in NaB-treated rats. Meanwhile, a 2.1-fold increase in co-expression of GFAP and NGF was also determined in rats received NaB enemas. In cultured cells, both NaB and TSA treatment could cause obvious NGF expression. Thus, butyrate might regulate EGC function via histone deacetylase inhibition.

CONCLUSIONS & INFERENCES

Butyrate-EGC interplay may play a pivotal role in regulation of NGF expression and the development of colonic hypersensitivity in IBS-like animal model.

[Effect of temporomandibular joint disc perforation on expression of type Ⅰ collagen in temporomandibular joint disc cells]

Objective: To investigate the effect of temporomandibular joint (TMJ) disc perforation on expression of type Ⅰ collagen in TMJ disc cells. Methods: The fibroblastic-like cells from the surgical removed TMJ disc tissue (disc perforation or TMJ condyle hyperplasia) were cultured. The cultured cells were identified as fibroblastic-like cells by toluidine blue and immunofluorescence staining. The expression of type Ⅰ collagen was detected with Western blotting and the content of type Ⅰ collagen was examined by enzyme linked immunosorbent assay (ELISA). Results: Fibroblastic-like cells were cultured from TMJ disc cells and the controls. The collagen-Ⅰ and collagen-Ⅱ were positive in both toluidine blue and immunofluorescence staining. In Western blotting, the expression of typeⅠcollagen in cells from joints with disc perforation was lower than that from normal joints. The content of collagen-Ⅰ was (1.62±0.52) μg/L from controls, and (0.85±0.33) μg/L from disc perforation respectively (P=0.0134). Conclusions: The disc cells from TMJ with disc perforation expressed lower type Ⅰ collagen than that from controls, which may be related to the lower content of collagen-Ⅰ in TMJ disc and the formation of TMJ disc perforation.

Clinical features, long-term clinical outcomes, and prognostic factors of tuberculous meningitis in West China: a multivariate analysis of 154 adults

BACKGROUND

Tuberculosis is prevalent in China, which is the second greatest contributor to the global tuberculosis burden. Tuberculosis meningitis (TBM) is the most severe disease form but few reports describe long-term clinical outcomes and prognostic factors. Thus, we studied these features in Chinese TBM patients.

METHODS

A retrospective follow-up study was used to collect clinical features and outcomes of adult TB meningitis at the First Affiliated Hospital of Chongqing Medical University from June 2012 to August 2015. Univariate analysis and multivariate analysis were used to identify predictive factors associated with outcomes at discharge and follow-up.

RESULTS

TBM patients (N = 154) were a median age of 41 years (range: 16-82 years). Median time to follow-up was 26.4 months (range: 9.3-46.5 months) and 31% had poor outcomes at follow-up and limb weakness (p = 0.016), lower GCS scores (p < 0.001), cranial-nerve palsy (p = 0.024), and hydrocephalus (p = 0.009) were closely associated with these poor outcomes. Furthermore, a high neutrophil to lymphocytes ratio, high D-dimer, a low albumin to globulin ratio and slow background of EEG associated with poor outcomes as well.

CONCLUSIONS

Mortality and disability associated with TBM are high in China. Limb weakness, GCS scores, cranial-nerve palsy and hydrocephalus were independent predictors of poor outcomes, and AGR, NLR, D-dimer, and EEG abnormalities may be prognostic factors of TBM.

[Impact of atmospheric particulate matter at different period of gestation on low birth weight: a meta-analysis]

Objective: To analyze the influence of atmospheric particulate matters (PM(2.5) and PM(10)) on low-birth-weight (LBW) infants at different periods of gestation. Methods: We conducted a systematic literature search for 2 471 articles related to particulate matter and LBW published from January 1st 2000 to January 1st 2016 using the PubMed, Cochrane Library, Web of Science, Science Direct, Chinese Web of Knowledge, Wanfang and Weipu, and the keywords were" air pollution" , "adverse birth outcomes" , "adverse pregnancy outcomes" , "low birth weight/LBW" . According to criteria, 27 literatures were selected and included. Metafor package of the R 3.1.1 Software was used to check the heterogeneity and merge the effect value of the selected literatures, and sensitivity analysis and publication bias were detected and adjusted. Results: A total of 2 471 studies selected form the databases, 27 enrolled in this analysis according to the inclusion and exclusion criteria. Each 10 μg/m(3) increase in PM(2.5) was associated with combined OR values of 1st trimester, 2nd trimester, 3rd trimester and entire gestation at 1.02(95% CI: 0.87-1.19), 1.03 (95% CI: 0.91-1.16) , 1.07 (95%CI: 1.04-1.11) and 1.09 (95%CI: 1.04-1.15), respectively. And 10 μg/m(3) increase in PM(10) was associated with combined OR values of 1st trimester, 2nd trimester, 3rd trimester and entire gestation at 1.66 (95%CI: 1.06-2.61), 1.58 (95%CI:1.28-1.95) , 1.38 (95%CI: 1.23-1.56) and 1.04 (95%CI: 0.99-1.09), respectively. After adjusting the bias of publication, each 10 μg/m(3) increase in PM(2.5) was associated with the risk of low birth weight at 1.11 (95%CI: 1.02-1.21). Conclusion: This meta analysis supports an adverse impact of maternal exposure to particulate air pollution on low birth weight, varying in effects by exposure period.

BDNF modulates intestinal barrier integrity through regulating the expression of tight junction proteins

BACKGROUND

Brain-derived neurotrophic factor (BDNF) may play a vital role in the homeostatic regulation of intestinal barrier integrity. We aimed to investigate the physiological role of BDNF in maintaining the intestinal epithelial barrier using postinflammatory irritable bowel syndrome (PI-IBS) mice and explore the underlying molecular mechanisms using intestinal epithelial cells in vitro.

METHODS

Postinflammatory-IBS mice were induced by intrarectal administration of trinitrobenzene sulfonic acid and allowed to recover for 28 days. Frequency of defecation, fecal water content, colonic epithelial integrity and expressions of BDNF and tight junction (TJ) proteins (occludin, ZO-1, claudin-1, claudin-2) of the PI-IBS mice were investigated. Based on the results of animal studies, we further performed RT-PCR and Western blots to assess how BDNF stimulation and BDNF knockdown impacted TJ proteins in the ht-29 intestinal epithelial cells.

KEY RESULTS

Water content of stools was significantly increased in the PI-IBS mice compared with controls. Colonic mucosa from the PI-IBS mice displayed epithelial barrier defects and exhibited increased protein expressions of BDNF and claudin-2 and decreased protein expressions of occludin, ZO-1 and claudin-1. Furthermore, a siRNA against BDNF in the ht-29 cells could effectively suppress BDNF gene and protein expressions, and subsequently reduce TJ gene and protein levels. When the ht-29 cells were incubated with different doses of exogenous BDNF, significant increases of occludin, ZO-1 and claudin-1 and decreases of claudin-2 protein were observed.

CONCLUSIONS & INFERENCES

BDNF may play a role in regulating intestinal epithelial barrier via affecting the expression of TJ proteins.

Systolic blood pressure estimation using PPG and ECG during physical exercise

In this work, a model to estimate systolic blood pressure (SBP) using photoplethysmography (PPG) and electrocardiography (ECG) is proposed. Data from 19 subjects doing a 40 min exercise was analyzed. Reference SBP was measured at the finger based on the volume-clamp principle. PPG signals were measured at the finger and forehead. After an initialization process for each subject at rest, the model estimated SBP every 30 s for the whole period of exercise. In order to build this model, 18 features were extracted from PPG signals by means of its waveform, first derivative, second derivative, and frequency spectrum. In addition, pulse arrival time (PAT) was derived as a feature from the combination of PPG and ECG. After evaluating four regression models, we chose multiple linear regression (MLR) to combine all derived features to estimate SBP. The contribution of each feature was quantified using its normalized weight in the MLR. To evaluate the performance of the model, we used a leave-one-subject-out cross validation. With the aim of exploring the potential of the model, we investigated the influences of the inclusion of PAT, regression models, measurement sites (finger and forehead), and posture change (lying, sitting, and standing). The results show that the inclusion of PAT reduced the standard deviation (SD) of the difference from 14.07 to 13.52 mmHg. There was no significant difference in the estimation performance between the model using finger- and forehead-derived PPG signals. Separate models are necessary for different postures. The optimized model using finger-derived PPG signals during physical exercise had a performance with a mean difference of 0.43 mmHg, an SD of difference of 13.52 mmHg, and median correlation coefficients of 0.86. Furthermore, we identified two groups of features that contributed more to SBP estimation compared to other features. One group consists of our proposed features depicting beat morphology. The other comprises existing features depicting the dicrotic notch. The present work demonstrates promising results of the SBP estimation model during physical exercise.

MicroRNA221-3p modulates Ets-1 expression in synovial fibroblasts from patients with osteoarthritis of temporomandibular joint

OBJECTIVE

This study aimed to screen differential expression of microRNAs (miRNAs), and investigate function of the specifically selected miRNA in synovial fibroblasts from patients suffering osteoarthritis of temporomandibular joint (TMJOA).

METHODS

MiRNA microarray was used to select differentially expressed miRNAs between TMJOA and normal synovial fibroblasts. The expression of screened miRNA221-3p was quantified using real-time PCR, and its specific target gene was predicted by bioinformatics. After transfection of miRNA221-3p mimics or inhibitor into synovial fibroblasts, the expression of v-Ets avian erythroblastosis virus E26 oncogene homolog 1 (Ets-1) was detected by immunohistochemistry, real-time PCR and Western blot, respectively. Dual luciferase activity was performed to identify the direct regulation of miRNA221-3p on Ets-1. Interlukin-1β (IL-1β) mimics an inflammatory situation.

RESULTS

In TMJOA synovial fibroblasts, eight miRNAs were up-regulated and six miRNAs were down-regulated. MiRNA221-3p was the most down-expressed. A sequence in the 3'-untranslated (3'-UTR) of Ets-1 complementary to the seed sequence of miRNA221-3p. Elevated expression of Ets-1 associated with attenuation of miRNA221-3p. Over-expression of miRNA221-3p suppressed the activity of a reporter construct containing the 3'-UTR of Ets-1 transcript and inhibited the expression of Ets-1 as well as its downstream molecules, matrix metalloproteinase 1 (MMP1) and MMP9 in TMJOA synovial fibroblasts. IL-1β suppressed the expression of miRNA221-3p in both a dose-dependent and time-dependent manner.

CONCLUSION

The reduction of miRNA221-3p in synovial fibroblasts, attributed from abundance of IL-1β in inflamed circumstance, induces Ets-1 up-regulation and then, initiates MMP1 and MMP9 secretion, thereby leading to continuously pathological development in TMJOA.

Association of COL1A1 polymorphism with subchondral bone degeneration of the temporomandibular joint

The G/T polymorphism of the COL1A1 gene exhibits a clinically significant influence on bone remodelling, leading to a predisposition to degenerative diseases. The enhancement of bone turnover and further loss of bone mass are thought to be the primary pathological changes in the early degenerative course of temporomandibular joint osteoarthritis (TMJ OA), with the appearance of low-density lesions. Thus, it was hypothesized that this polymorphism may also affect this type of bone lesion in TMJ OA. A total of 130 TMJ OA patients with low-density lesions (cortical bone erosion, condylar head resorption, cyst-like lesion) and 186 healthy individuals were recruited. DNA samples were extracted from buccal mucosa swabs; genotyping was performed by high-resolution melting assay. The distribution of genotypes in these groups was compared using a multivariate logistic regression model. No significant differences in the distributions of TT and TG genotypes were observed between the groups (P>0.05). Significance was detected for GG homozygous carriers (P=0.043); this genotype might be a risk factor for this type of low-density lesion (odds ratio 1.643, 95% confidence interval 1.016-2.658). This study indicates that the GG genotype might be a risk factor for low-density lesions in the TMJ.

Consequences of urban pollution upon skin status. A controlled study in Shanghai area

OBJECTIVE

After preliminary studies aimed at measuring pertinent biochemical parameters, potentially modified in subjects exposed to bad environmental conditions, a dedicated study was performed in Shanghai city to evaluate the effect of Urban pollution upon human skin and to collect feedback from the volunteers under study.

METHODS

This study was performed during summer 2008 in two different districts of Shanghai, on 159 local residents: 79 subjects from Xu Jia Hui (a centre Shanghainese area), more exposed to pollution, and 80 subjects from Chong Ming, an agricultural region closely located north of Shanghai (<100 kms) and less exposed to pollution, according to official data. Biochemical parameters were measured on skin, and feedback from volunteers was collected through a graduated 'Likert scale' questionnaire under a point scale (strongly agree, agree, disagree, strongly disagree and none).

RESULTS

The study demonstrated significant differences in several biochemical parameters measured in Chong Ming area, as compared to Urban area, with an increased ratio of squalene/lipids, a lower level of lactic acid and a better cohesion of stratum corneum. Both sebum excretion rate and sebum casual levels did not differ between the two districts. The volunteer's feedback evidenced a perceived link between pollution and their skin problems.

CONCLUSION

This study demonstrated a significant impact of the pollution upon the skin status, as illustrated by changes in superficial biochemical parameters and volunteers' perception.

Diagnostic performance of magnetic resonance imaging for acute pulmonary embolism: a systematic review and meta-analysis

BACKGROUND

With ongoing technical developments, magnetic resonance imaging (MRI) has notably evolved for the assessment of the pulmonary vasculature. However, uncertainty persists about the performance of MRI for the diagnosis of acute pulmonary embolism (APE).

OBJECTIVES

To clarify the comprehensive role of MRI in diagnosing APE.

METHODS

Studies were identified through a search of Pubmed and Ovid databases, and the QUADAS-2 tool was applied for quality assessment of the included studies.

RESULTS

Fifteen studies based on patients and nine based on vessels were retrieved. The patient-based analysis yielded an overall sensitivity of 0.75 (95% confidence interval, 0.70-0.79) and 0.84 (0.80-0.87) for all patients and patients with technically adequate images, respectively, with an overall specificity of 0.80 (0.77-0.83) and 0.97 (0.96-0.98) and a pooled diagnostic odds ratio (DOR) of 51.07 (18.36-142.05) and 155.22 (86.83-277.47). On average, MRI was technically inadequate in 18.89% of patients (range, 2.10%-27.70%). A direct comparison of different MRI modalities showed that the combined MRI test had the highest pooled DOR and the lowest proportion of inconclusive images. Of note, heterogeneity and moderate quality were observed. On a vessel basis, the MRI had high sensitivity and specificity in larger-order vessels, but a significantly lower sensitivity of 0.55 (0.50-0.60) for subsegmental APE.

CONCLUSIONS

On a patient-based level, MRI yields high diagnostic accuracy for the detection of APE, especially in technically adequate images, and the inconclusive MRI examinations mainly result from motion artifact and poor arterial opacification. The combined MRI test appears to be a more promising diagnostic tool with greater power of discrimination than single techniques. From a vessel-based perspective, MRI exhibits a high diagnostic capability with proximal arteries, but lacks sensitivity for peripheral embolism.